The purpose of this project is to explore relationships among mental and physical health issues, and predictors of anxiety and depression among college students. While mental health is sometimes hard to measure, there are standardized methods developed to help psychologists evaluate the presence and severity of certain mental health indicators. In this project, we will focus mainly on depression and anxiety disorders in relation to overall mental health.
Our physical and mental health are not distinct from each other. It is important to view health from an overall perspective, because all areas of our lives cross over into each other.
Data Description
The data set comes from a study based on social media’s affects on college students’ mental health (Braghieri, et. al 2021). The data includes variables with information from PHQ-9 Depression Screening Surveys and GAD-7 Anxiety Screening Surveys. Both are highly reliable and valid in medical diagnoses. Additionally, there are survey questions derived from the American College Health Association (ACHA)’s National College Health Assessment (NCHA). This data set was originally used to evaluate the validity of the NCHA by comparing the outcomes to the PHQ-9 and the GAD-7, both of which were highly correlated to the poor mental health predictors of the NCHA. There are 509 observations.
Rows: 509
Columns: 88
$ RecordedDate <chr> "1/29/2022 15:37", "1/29/2022 15:4…
$ year_1 <dbl> 2000, 1997, 2000, 2001, 2000, 2000…
$ state_1 <chr> "Virginia", "California", "Marylan…
$ surveys <chr> "15", "15", "1", "7", "5", "30", "…
$ general_health <chr> "Good", "Excellent", "Very Good", …
$ phq9_interest <chr> "More than half of the days", "Not…
$ phq9_depressed <chr> "Several days", "Not at all", "Sev…
$ phq9_sleep <chr> "Several days", "Not at all", "Not…
$ phq9_tired <chr> "Several days", "Several days", "S…
$ phq9_appetite <chr> "Several days", "Several days", "N…
$ phq9_failure <chr> "More than half of the days", "Not…
$ phq9_concentrating <chr> "Several days", "Not at all", "Mor…
$ phq9_speed <chr> "Not at all", "Not at all", "Not a…
$ phq9_selfharm <chr> "Not at all", "Not at all", "Sever…
$ gad7_anxious <chr> "Several days", "Not at all", "Sev…
$ gad7_control <chr> "Several days", "Not at all", "Not…
$ gad7_worrying <chr> "Several days", "Not at all", "Not…
$ gad7_relaxing <chr> "Several days", "Not at all", "Not…
$ gad7_restless <chr> "Several days", "Not at all", "Not…
$ gad7_annoyed <chr> "Several days", "Not at all", "Mor…
$ gad7_afraid <chr> "Several days", "Not at all", "Sev…
$ acha_12months_times_hopeless <chr> "5-6 times", "Never", "1-2 times",…
$ acha_12months_times_overwhelmed <chr> "5-6 times", "11 or more times", "…
$ acha_12months_times_exhausted <chr> "5-6 times", "5-6 times", "7-8 tim…
$ acha_12months_times_sad <chr> "5-6 times", "3-4 times", "1-2 tim…
$ acha_12months_times_depressed <chr> "1-2 times", "Never", "1-2 times",…
$ acha_12months_times_considerSuicide <chr> "Never", "Never", "1-2 times", "3-…
$ acha_12months_times_attemptSuicide <chr> "Never", "Never", "Never", "Never"…
$ acha_12months_any_allergy <chr> "No", "No", "No", "Yes", "No", "No…
$ acha_12months_any_anorexia <chr> "No", "No", "No", "No", "No", "No"…
$ acha_12months_any_anxiety <chr> "Yes", "No", "No", "Yes", "Yes", "…
$ acha_12months_any_asthma <chr> "No", "No", "No", "No", "No", "No"…
$ acha_12months_any_bulimia <chr> "No", "No", "No", "No", "No", "No"…
$ acha_12months_any_fatigure <chr> "No", "No", "No", "No", "No", "No"…
$ acha_12months_any_depression <chr> "Yes", "No", "No", "Yes", "Yes", "…
$ acha_12months_any_diabetes <chr> "No", "No", "No", "No", "Yes", "No…
$ acha_12months_any_endometriosi <chr> "No", "No", "No", "Yes", "No", "No…
$ acha_12months_any_herpes <chr> "No", "No", "No", "No", "No", "No"…
$ acha_12months_any_hpv <chr> "No", "No", "No", "No", "No", "No"…
$ acha_12months_any_hepatitis <chr> "No", "No", "No", "No", "No", "No"…
$ acha_12months_any_blood <chr> "No", "No", "No", "No", "No", "No"…
$ acha_12months_any_cholesterol <chr> "No", "No", "No", "No", "No", "No"…
$ acha_12months_any_HIV <chr> "No", "No", "No", "No", "No", "No"…
$ acha_12months_any_stressInjury <chr> "No", "No", "No", "No", "No", "No"…
$ acha_12months_any_seasonal <chr> "Yes", "No", "No", "No", "No", "No…
$ acha_12months_any_substance <chr> "No", "Yes", "No", "No", "No", "No…
$ acha_12months_any_back <chr> "No", "Yes", "No", "No", "No", "Ye…
$ acha_12months_any_fracture <chr> "No", "No", "No", "No", "No", "No"…
$ acha_12months_any_bronchitis <chr> "No", "No", "No", "No", "No", "No"…
$ acha_12months_any_chlamydia <chr> "No", "No", "No", "No", "No", "No"…
$ acha_12months_any_ear <chr> "No", "No", "No", "No", "No", "No"…
$ acha_12months_any_gonorrhea <chr> "No", "No", "No", "No", "No", "No"…
$ acha_12months_any_mononucleosis <chr> "No", "No", "No", "No", "No", "No"…
$ acha_12months_any_pelvic <chr> "No", "No", "No", "No", "No", "No"…
$ acha_12months_any_sinus <chr> "No", "No", "No", "No", "Yes", "Ye…
$ acha_12months_any_strep <chr> "No", "No", "No", "Yes", "No", "No…
$ acha_12months_any_tuberculosis <chr> "No", "No", "No", "No", "No", "No"…
$ acha_services_dianosed <chr> "No", NA, "No", "Yes", "No", NA, "…
$ acha_services_therapy <chr> "Yes", NA, "No", "Yes", "Yes", NA,…
$ acha_services_medication <chr> "Yes", NA, "No", "Yes", "Yes", NA,…
$ acha_depression <chr> "Yes", "No", "No", "Yes", "Yes", "…
$ sex <chr> "Female", "Female", "Female", "Fem…
$ fulltime <chr> "Yes", "Yes", "Yes", "Yes", "Yes",…
$ international <chr> "No", "No", "No", "No", "No", "No"…
$ race <chr> "white", "asian", "asian", "white"…
$ phq9_interest1 <dbl> 2, 0, 1, 2, 2, 1, 1, 1, 1, 1, 0, 1…
$ phq9_depressed1 <dbl> 1, 0, 1, 2, 2, 1, 1, 1, 1, 1, 1, 1…
$ phq9_sleep1 <dbl> 1, 0, 0, 3, 2, 1, 2, 3, 3, 0, 1, 0…
$ phq9_tired1 <dbl> 1, 1, 1, 3, 2, 2, 2, 1, 3, 2, 1, 2…
$ phq9_appetite1 <dbl> 1, 1, 0, 3, 1, 1, 1, 3, 0, 1, 1, 1…
$ phq9_failure1 <dbl> 2, 0, 0, 1, 2, 2, 1, 2, 1, 0, 1, 0…
$ phq9_concentrating1 <dbl> 1, 0, 2, 3, 1, 2, 1, 1, 1, 0, 1, 0…
$ phq9_speed1 <dbl> 0, 0, 0, 1, 0, 0, 1, 2, 1, 0, 0, 0…
$ phq9_selfharm1 <dbl> 0, 0, 1, 1, 2, 0, 0, 1, 0, 0, 0, 0…
$ phq9_score <dbl> 9, 2, 6, 19, 14, 10, 10, 15, 11, 5…
$ phq9_severity <chr> "Mild", "None-minimal", "Mild", "M…
$ gad7_anxious1 <dbl> 1, 0, 1, 1, 1, 1, 2, 2, 1, 3, 2, 3…
$ gad7_control1 <dbl> 1, 0, 0, 0, 1, 2, 2, 1, 1, 3, 1, 3…
$ gad7_worrying1 <dbl> 1, 0, 0, 1, 1, 2, 2, 2, 1, 3, 2, 3…
$ gad7_relaxing1 <dbl> 1, 0, 0, 2, 1, 1, 2, 1, 2, 3, 2, 3…
$ gad7_restless1 <dbl> 1, 0, 0, 2, 1, 0, 2, 1, 2, 2, 1, 1…
$ gad7_annoyed1 <dbl> 1, 0, 2, 2, 2, 3, 2, 2, 0, 3, 1, 3…
$ gad7_afraid1 <dbl> 1, 0, 1, 0, 1, 0, 2, 1, 0, 1, 0, 1…
$ gad7_score <dbl> 7, 0, 4, 8, 8, 9, 14, 10, 7, 18, 9…
$ gad7_severity <chr> "Mild Anxiety", "Minimal Anxiety",…
$ acha_services_diagnosed1 <chr> "No", NA, NA, "Yes", "No", NA, "No…
$ acha_services_therapy1 <chr> "Yes", NA, NA, "Yes", "Yes", NA, "…
$ acha_services_medication1 <chr> "Yes", NA, NA, "Yes", "Yes", NA, "…
The PHQ-9 is a standardized survey used to screen and diagnose depression. Participants are asked how often they have been bothered by nine specific problems over the past two weeks and respond with one of the four answers:
The nine prompts consist of the following:
Surveys are then scored and indicate levels of depression based on this scale:
Similar to the PHQ-9, the GAD-7 another is standardized survey, but it is used to screen generalized anxiety disorder. Participants are asked how often they have been bothered by seven specific problems over the past two weeks and respond with one of the four answers:
The nine prompts consist of the following:
Surveys are then scored and indicate levels of anxiety based on this scale:
The National College Health Assessment is a semi-annual survey administered to college students by the ACHA. The current data utilizes the survey questions, but not the data collected from the ACHA.
The data includes the following prompts from the survey:
Depression Symptoms:
Possible Responses:
General Health Indicators: Reported any of the following in the past 12 months:
Possible Responses:
If diagnosed with depression:
Possible Responses:
Many variables that were not useful for the research questions and were removed from the data set. Most of these include timestamps from clicks in the survey and other online browser information.
Other variables were created and transformed for ease of use. For example, race was condensed into one category with information for all races as opposed to 6 different variables with two levels.
Additionally, variables were created to represent the overall depression and anxiety scores from the PHQ-9 and GAD-7 screening results.
Discussion
Figure 1
This graph provides some insight into the relationship between overall PHQ-9 and GAD-7 scores. The R-Squared = 0.605 and the regression line is fitted by a linear regression between the variables. There is a moderate, positive relationship between the depression and anxiety scores based on these survey questions.
Figure 2
Figure 2 shows the distribution of depression severity based on the PHQ-9. Most students fall under the Mild category, with less having more severe scores.
Figure 3
Figure 3 shows the distribution of anxiety severity based on the GAD-7. The results are similar to the distribution of depression, with most students exhibiting symptoms equivalent to mild anxiety and less facing severe symptoms.
Figure 4
Figure 4 shows how many male and female students are included in the dataset. There are approximately 350 females and 150 males.
Figure 5
Most students identify as white, with almost 300 students reporting so. All students who idenfied as more than one race are classified as “other”.
Figure 6
Most students were born in the year 2000, with a long tail representing multiple older students also represented in the sample. Note: This data was collected in January 2022, so most students born in 2000 are around 21 years old.
Figure 7
This graph shows the amount of people who responded “yes” to experiencing each of the symptoms/disorders listed in the past 12 months. Anxiety, depression, allergies, and back pain are among the most common.
It is worth noting these measures of depression and anxiety are different from the PHQ-9 and GAD-7 scales, and were an independent, self-reported question in the NCHA questionnaire.
Corresponding Graphs
gekk
No Yes
275 133
No Yes
64 37
Call:
glm(formula = acha_depression_01 ~ sex + race + year_1 + phq9_score +
gad7_score + general_health, family = binomial, data = train)
Coefficients:
Estimate Std. Error z value Pr(>|z|)
(Intercept) 145.37538 48.32911 3.008 0.002629 **
sexMale -0.34449 0.27455 -1.255 0.209574
raceblack -0.37417 0.73117 -0.512 0.608834
racehispanic 0.66731 0.49416 1.350 0.176885
raceother 0.83632 0.51258 1.632 0.102766
racewhite 1.32422 0.37300 3.550 0.000385 ***
year_1 -0.07419 0.02416 -3.071 0.002131 **
phq9_score 0.11448 0.03121 3.668 0.000245 ***
gad7_score -0.04929 0.03292 -1.497 0.134387
general_healthFair 0.76431 0.63969 1.195 0.232160
general_healthGood 0.63939 0.59108 1.082 0.279375
general_healthPoor 1.68661 0.77067 2.188 0.028635 *
general_healthVery Good 0.54631 0.59794 0.914 0.360895
---
Signif. codes: 0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
(Dispersion parameter for binomial family taken to be 1)
Null deviance: 515.14 on 407 degrees of freedom
Residual deviance: 442.18 on 395 degrees of freedom
AIC: 468.18
Number of Fisher Scoring iterations: 4
Call:
glm(formula = acha_depression_01 ~ sex + race + year_1 + acha_12months_any_allergy +
acha_12months_any_asthma + acha_12months_any_back + acha_12months_any_blood +
acha_12months_any_bronchitis + acha_12months_any_cholesterol +
acha_12months_any_diabetes + acha_12months_any_ear + acha_12months_any_endometriosi +
acha_12months_any_fatigure + acha_12months_any_hepatitis +
acha_12months_any_pelvic + acha_12months_any_sinus + acha_12months_any_strep +
acha_12months_any_stressInjury + acha_12months_any_tuberculosis +
general_health, family = binomial, data = train)
Coefficients:
Estimate Std. Error z value Pr(>|z|)
(Intercept) 104.68619 49.48934 2.115 0.034402 *
sexMale -0.40080 0.27986 -1.432 0.152096
raceblack -0.36919 0.73219 -0.504 0.614100
racehispanic 0.57032 0.50800 1.123 0.261566
raceother 0.91496 0.54025 1.694 0.090346 .
racewhite 1.26868 0.37922 3.346 0.000821 ***
year_1 -0.05372 0.02473 -2.173 0.029793 *
acha_12months_any_allergyYes 0.21398 0.25352 0.844 0.398661
acha_12months_any_asthmaYes 0.64099 0.35269 1.817 0.069151 .
acha_12months_any_backYes 0.23919 0.24844 0.963 0.335652
acha_12months_any_bloodYes -0.43401 0.57323 -0.757 0.448974
acha_12months_any_bronchitisYes -0.47910 0.76505 -0.626 0.531166
acha_12months_any_cholesterolYes 0.46906 0.58020 0.808 0.418839
acha_12months_any_diabetesYes 2.10914 1.18240 1.784 0.074459 .
acha_12months_any_earYes 0.36444 0.53069 0.687 0.492255
acha_12months_any_endometriosiYes 0.84044 0.83113 1.011 0.311923
acha_12months_any_fatigureYes 0.05289 0.48733 0.109 0.913581
acha_12months_any_hepatitisYes 1.01933 1.99811 0.510 0.609951
acha_12months_any_pelvicYes -1.12601 2.07489 -0.543 0.587348
acha_12months_any_sinusYes -0.02874 0.31204 -0.092 0.926619
acha_12months_any_strepYes -0.17350 0.42806 -0.405 0.685239
acha_12months_any_stressInjuryYes 0.08513 0.56033 0.152 0.879241
acha_12months_any_tuberculosisYes -14.68387 535.41877 -0.027 0.978121
general_healthFair 1.09215 0.63196 1.728 0.083955 .
general_healthGood 0.90145 0.58451 1.542 0.123019
general_healthPoor 1.95796 0.80116 2.444 0.014529 *
general_healthVery Good 0.59285 0.59520 0.996 0.319227
---
Signif. codes: 0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
(Dispersion parameter for binomial family taken to be 1)
Null deviance: 515.14 on 407 degrees of freedom
Residual deviance: 446.57 on 381 degrees of freedom
AIC: 500.57
Number of Fisher Scoring iterations: 12
Call:
glm(formula = acha_depression_01 ~ sex + race + year_1 + acha_12months_any_anorexia +
acha_12months_any_anxiety + acha_12months_any_bulimia + acha_12months_any_blood +
acha_12months_any_bronchitis + acha_12months_any_cholesterol +
acha_12months_any_depression + acha_12months_any_herpes +
acha_12months_any_hpv + acha_12months_any_HIV + acha_12months_any_seasonal +
acha_12months_any_substance + acha_12months_any_chlamydia +
acha_12months_any_gonorrhea + acha_12months_any_mononucleosis +
general_health, family = binomial, data = train)
Coefficients:
Estimate Std. Error z value Pr(>|z|)
(Intercept) 182.83294 67.84713 2.695 0.00704 **
sexMale 0.20936 0.41205 0.508 0.61139
raceblack -1.13158 0.85762 -1.319 0.18702
racehispanic 0.59847 0.64535 0.927 0.35374
raceother 0.67669 0.72304 0.936 0.34933
racewhite 1.36900 0.51759 2.645 0.00817 **
year_1 -0.09373 0.03394 -2.762 0.00575 **
acha_12months_any_anorexiaYes -1.23366 0.62469 -1.975 0.04829 *
acha_12months_any_anxietyYes 1.09342 0.39879 2.742 0.00611 **
acha_12months_any_bulimiaYes 0.64044 0.75661 0.846 0.39729
acha_12months_any_bloodYes -1.27045 0.72711 -1.747 0.08059 .
acha_12months_any_bronchitisYes -0.49642 0.85238 -0.582 0.56030
acha_12months_any_cholesterolYes -0.22546 0.70531 -0.320 0.74923
acha_12months_any_depressionYes 3.42833 0.38732 8.852 < 2e-16 ***
acha_12months_any_herpesYes 0.77435 1.95422 0.396 0.69192
acha_12months_any_hpvYes 2.39706 1.88855 1.269 0.20435
acha_12months_any_HIVYes -33.78101 2058.24531 -0.016 0.98691
acha_12months_any_seasonalYes 0.18902 0.40446 0.467 0.64026
acha_12months_any_substanceYes 0.99055 0.64239 1.542 0.12308
acha_12months_any_chlamydiaYes 1.28855 1.41627 0.910 0.36291
acha_12months_any_gonorrheaYes 17.76550 1455.39890 0.012 0.99026
acha_12months_any_mononucleosisYes 0.64815 1.29923 0.499 0.61787
general_healthFair 0.68607 0.82714 0.829 0.40685
general_healthGood 0.29145 0.77594 0.376 0.70720
general_healthPoor 1.16951 1.00704 1.161 0.24551
general_healthVery Good 0.26623 0.78974 0.337 0.73603
---
Signif. codes: 0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
(Dispersion parameter for binomial family taken to be 1)
Null deviance: 515.14 on 407 degrees of freedom
Residual deviance: 258.88 on 382 degrees of freedom
AIC: 310.88
Number of Fisher Scoring iterations: 14
acha_12months_any_gonorrhea
No Yes
506 3
No Yes
406 2
Call:
glm(formula = acha_depression_01 ~ sex + race + year_1 + acha_12months_any_anorexia +
acha_12months_any_anxiety + acha_12months_any_bulimia + acha_12months_any_blood +
acha_12months_any_bronchitis + acha_12months_any_cholesterol +
acha_12months_any_depression + acha_12months_any_herpes +
acha_12months_any_hpv + acha_12months_any_HIV + acha_12months_any_seasonal +
acha_12months_any_substance + acha_12months_any_chlamydia +
acha_12months_any_mononucleosis + acha_12months_any_allergy +
acha_12months_any_asthma + acha_12months_any_back + acha_12months_any_blood +
acha_12months_any_bronchitis + acha_12months_any_cholesterol +
acha_12months_any_diabetes + acha_12months_any_ear + acha_12months_any_endometriosi +
acha_12months_any_fatigure + acha_12months_any_hepatitis +
acha_12months_any_pelvic + acha_12months_any_sinus + acha_12months_any_strep +
acha_12months_any_stressInjury + general_health, family = binomial,
data = train)
Coefficients:
Estimate Std. Error z value Pr(>|z|)
(Intercept) 176.91113 73.47297 2.408 0.01605 *
sexMale 0.22157 0.44033 0.503 0.61483
raceblack -1.07790 0.93189 -1.157 0.24740
racehispanic 0.57350 0.69207 0.829 0.40729
raceother 1.20341 0.79366 1.516 0.12945
racewhite 1.61169 0.54971 2.932 0.00337 **
year_1 -0.09087 0.03676 -2.472 0.01344 *
acha_12months_any_anorexiaYes -1.26806 0.64498 -1.966 0.04929 *
acha_12months_any_anxietyYes 1.12118 0.41867 2.678 0.00741 **
acha_12months_any_bulimiaYes 0.77601 0.77839 0.997 0.31880
acha_12months_any_bloodYes -1.07135 0.76219 -1.406 0.15984
acha_12months_any_bronchitisYes -1.11971 0.96716 -1.158 0.24697
acha_12months_any_cholesterolYes -0.43014 0.77641 -0.554 0.57957
acha_12months_any_depressionYes 3.60869 0.41065 8.788 < 2e-16 ***
acha_12months_any_herpesYes 3.19156 1.51269 2.110 0.03487 *
acha_12months_any_hpvYes 2.69665 2.00895 1.342 0.17949
acha_12months_any_HIVYes -19.73801 882.76160 -0.022 0.98216
acha_12months_any_seasonalYes 0.26618 0.44153 0.603 0.54661
acha_12months_any_substanceYes 0.96999 0.68454 1.417 0.15648
acha_12months_any_chlamydiaYes 0.76344 1.37100 0.557 0.57763
acha_12months_any_mononucleosisYes 0.76147 1.47864 0.515 0.60657
acha_12months_any_allergyYes 0.13980 0.36510 0.383 0.70178
acha_12months_any_asthmaYes 0.55782 0.52277 1.067 0.28595
acha_12months_any_backYes -0.08049 0.36619 -0.220 0.82602
acha_12months_any_diabetesYes 2.04013 1.50091 1.359 0.17406
acha_12months_any_earYes 1.22705 0.74579 1.645 0.09991 .
acha_12months_any_endometriosiYes 0.67545 1.37549 0.491 0.62338
acha_12months_any_fatigureYes -1.05944 0.66545 -1.592 0.11137
acha_12months_any_hepatitisYes 1.62925 3.39041 0.481 0.63084
acha_12months_any_pelvicYes -1.36295 3.48193 -0.391 0.69548
acha_12months_any_sinusYes -0.75049 0.44727 -1.678 0.09336 .
acha_12months_any_strepYes -0.04781 0.58316 -0.082 0.93466
acha_12months_any_stressInjuryYes 0.10564 0.82998 0.127 0.89871
general_healthFair 0.49126 0.88670 0.554 0.57955
general_healthGood 0.22825 0.80970 0.282 0.77802
general_healthPoor 1.11352 1.08721 1.024 0.30574
general_healthVery Good 0.22503 0.82483 0.273 0.78499
---
Signif. codes: 0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
(Dispersion parameter for binomial family taken to be 1)
Null deviance: 515.14 on 407 degrees of freedom
Residual deviance: 248.94 on 371 degrees of freedom
AIC: 322.94
Number of Fisher Scoring iterations: 13
acha_12months_any_tuberculosis
No Yes
507 2
GVIF Df GVIF^(1/(2*Df))
sex 1.303618 1 1.141761
race 2.361095 4 1.113369
year_1 1.292202 1 1.136750
acha_12months_any_anorexia 1.385895 1 1.177240
acha_12months_any_anxiety 1.539437 1 1.240741
acha_12months_any_bulimia 1.357240 1 1.165006
acha_12months_any_blood 1.641962 1 1.281391
acha_12months_any_bronchitis 1.282037 1 1.132271
acha_12months_any_cholesterol 1.749921 1 1.322846
acha_12months_any_depression 1.474820 1 1.214422
acha_12months_any_herpes 1.312081 1 1.145461
acha_12months_any_hpv 1.100768 1 1.049175
acha_12months_any_HIV 1.000041 1 1.000021
acha_12months_any_seasonal 1.234406 1 1.111038
acha_12months_any_substance 1.157779 1 1.076001
acha_12months_any_chlamydia 1.267401 1 1.125789
acha_12months_any_mononucleosis 1.250364 1 1.118197
acha_12months_any_allergy 1.226155 1 1.107319
acha_12months_any_asthma 1.360707 1 1.166494
acha_12months_any_back 1.255588 1 1.120530
acha_12months_any_diabetes 1.147482 1 1.071206
acha_12months_any_ear 1.306483 1 1.143015
acha_12months_any_endometriosi 1.139945 1 1.067682
acha_12months_any_fatigure 1.406759 1 1.186069
acha_12months_any_hepatitis 1.407275 1 1.186286
acha_12months_any_pelvic 1.484279 1 1.218310
acha_12months_any_sinus 1.305845 1 1.142736
acha_12months_any_strep 1.277694 1 1.130351
acha_12months_any_stressInjury 1.124536 1 1.060442
general_health 2.546245 4 1.123926
gad7_severity
Mild Anxiety Minimal Anxiety Moderate Anxiety Severe Anxiety
169 149 111 80
No Yes
255 153
No Yes
255 255
No Yes
255 255
0 1
255 255
Call:
glm(formula = gad7_anxiety_up01 ~ sex + race + year_1 + phq9_score +
general_health, family = binomial, data = anxietytrain_up)
Coefficients:
Estimate Std. Error z value Pr(>|z|)
(Intercept) -62.61809 57.12337 -1.096 0.2730
sexMale -0.47301 0.32326 -1.463 0.1434
raceblack 0.13949 0.71257 0.196 0.8448
racehispanic -0.15011 0.59663 -0.252 0.8014
raceother 1.43956 0.59688 2.412 0.0159 *
racewhite 1.82197 0.44095 4.132 3.6e-05 ***
year_1 0.02869 0.02851 1.006 0.3144
phq9_score 0.44992 0.04221 10.658 < 2e-16 ***
general_healthFair -0.06425 0.72124 -0.089 0.9290
general_healthGood -0.82983 0.66042 -1.257 0.2089
general_healthPoor 1.36182 1.05475 1.291 0.1967
general_healthVery Good -0.34049 0.65254 -0.522 0.6018
---
Signif. codes: 0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
(Dispersion parameter for binomial family taken to be 1)
Null deviance: 707.01 on 509 degrees of freedom
Residual deviance: 343.25 on 498 degrees of freedom
AIC: 367.25
Number of Fisher Scoring iterations: 6
Call:
glm(formula = gad7_anxiety_up01 ~ sex + race + year_1 + acha_12months_any_allergy +
acha_12months_any_asthma + acha_12months_any_back + acha_12months_any_blood +
acha_12months_any_bronchitis + acha_12months_any_cholesterol +
acha_12months_any_diabetes + acha_12months_any_ear + acha_12months_any_endometriosi +
acha_12months_any_fatigure + acha_12months_any_hepatitis +
acha_12months_any_pelvic + acha_12months_any_sinus + acha_12months_any_strep +
acha_12months_any_stressInjury + acha_12months_any_tuberculosis +
general_health, family = binomial, data = anxietytrain_up)
Coefficients:
Estimate Std. Error z value Pr(>|z|)
(Intercept) -6.562e+01 5.348e+01 -1.227 0.219862
sexMale -5.860e-01 2.402e-01 -2.439 0.014714 *
raceblack -1.014e+00 5.788e-01 -1.752 0.079819 .
racehispanic 1.676e-01 4.090e-01 0.410 0.681998
raceother 3.127e-01 4.835e-01 0.647 0.517817
racewhite 8.598e-01 2.902e-01 2.963 0.003049 **
year_1 3.191e-02 2.672e-02 1.194 0.232440
acha_12months_any_allergyYes -1.359e-03 2.189e-01 -0.006 0.995044
acha_12months_any_asthmaYes 3.479e-01 3.193e-01 1.090 0.275874
acha_12months_any_backYes 3.014e-01 2.203e-01 1.368 0.171325
acha_12months_any_bloodYes 1.500e-01 5.716e-01 0.262 0.793044
acha_12months_any_bronchitisYes 7.928e-01 6.523e-01 1.215 0.224197
acha_12months_any_cholesterolYes 9.210e-01 5.219e-01 1.765 0.077599 .
acha_12months_any_diabetesYes -1.654e+00 9.145e-01 -1.809 0.070462 .
acha_12months_any_earYes 4.113e-01 4.928e-01 0.835 0.403929
acha_12months_any_endometriosiYes -7.926e-01 7.122e-01 -1.113 0.265798
acha_12months_any_fatigureYes 1.641e+00 5.532e-01 2.967 0.003007 **
acha_12months_any_hepatitisYes -1.281e+01 7.345e+02 -0.017 0.986085
acha_12months_any_pelvicYes 2.329e+01 1.039e+03 0.022 0.982111
acha_12months_any_sinusYes 3.517e-01 2.746e-01 1.281 0.200278
acha_12months_any_strepYes -1.379e-01 3.940e-01 -0.350 0.726307
acha_12months_any_stressInjuryYes -9.402e-01 6.366e-01 -1.477 0.139703
acha_12months_any_tuberculosisYes -2.576e+01 1.630e+03 -0.016 0.987394
general_healthFair 1.879e+00 5.216e-01 3.601 0.000317 ***
general_healthGood 1.025e+00 4.697e-01 2.183 0.029037 *
general_healthPoor 4.607e+00 1.014e+00 4.544 5.51e-06 ***
general_healthVery Good 6.365e-01 4.750e-01 1.340 0.180191
---
Signif. codes: 0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
(Dispersion parameter for binomial family taken to be 1)
Null deviance: 707.01 on 509 degrees of freedom
Residual deviance: 585.68 on 483 degrees of freedom
AIC: 639.68
Number of Fisher Scoring iterations: 14
Call:
glm(formula = gad7_anxiety_up01 ~ acha_depression_01 + sex +
race + year_1 + acha_12months_any_anorexia + acha_12months_any_anxiety +
acha_12months_any_bulimia + acha_12months_any_blood + acha_12months_any_bronchitis +
acha_12months_any_cholesterol + acha_12months_any_depression +
acha_12months_any_herpes + acha_12months_any_hpv + acha_12months_any_HIV +
acha_12months_any_seasonal + acha_12months_any_substance +
acha_12months_any_chlamydia + acha_12months_any_gonorrhea +
acha_12months_any_mononucleosis + general_health, family = binomial,
data = anxietytrain_up)
Coefficients:
Estimate Std. Error z value Pr(>|z|)
(Intercept) -51.80620 52.54818 -0.986 0.324192
acha_depression_01 -0.87866 0.35738 -2.459 0.013947 *
sexMale -0.22718 0.26494 -0.858 0.391168
raceblack -1.30041 0.61731 -2.107 0.035154 *
racehispanic 0.30334 0.44300 0.685 0.493507
raceother 0.35896 0.51330 0.699 0.484353
racewhite 0.61212 0.32580 1.879 0.060268 .
year_1 0.02462 0.02626 0.937 0.348524
acha_12months_any_anorexiaYes 0.52806 0.41495 1.273 0.203160
acha_12months_any_anxietyYes 1.93254 0.27855 6.938 3.98e-12 ***
acha_12months_any_bulimiaYes -0.11086 0.63608 -0.174 0.861642
acha_12months_any_bloodYes 0.18127 0.61256 0.296 0.767297
acha_12months_any_bronchitisYes 0.82715 0.72923 1.134 0.256675
acha_12months_any_cholesterolYes 0.76941 0.56378 1.365 0.172335
acha_12months_any_depressionYes 0.59409 0.34453 1.724 0.084650 .
acha_12months_any_herpesYes -15.76153 917.94403 -0.017 0.986301
acha_12months_any_hpvYes -1.26023 1.89565 -0.665 0.506179
acha_12months_any_HIVYes 13.65356 2985.12155 0.005 0.996351
acha_12months_any_seasonalYes 0.07511 0.31191 0.241 0.809702
acha_12months_any_substanceYes -0.37292 0.43846 -0.851 0.395036
acha_12months_any_chlamydiaYes -0.75734 1.04800 -0.723 0.469893
acha_12months_any_gonorrheaYes -12.79297 1520.03684 -0.008 0.993285
acha_12months_any_mononucleosisYes -1.49975 1.19181 -1.258 0.208256
general_healthFair 1.98638 0.58345 3.405 0.000663 ***
general_healthGood 1.08956 0.53527 2.036 0.041799 *
general_healthPoor 4.67970 1.04706 4.469 7.85e-06 ***
general_healthVery Good 0.77517 0.53813 1.440 0.149729
---
Signif. codes: 0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
(Dispersion parameter for binomial family taken to be 1)
Null deviance: 707.01 on 509 degrees of freedom
Residual deviance: 513.98 on 483 degrees of freedom
AIC: 567.98
Number of Fisher Scoring iterations: 15
Call:
glm(formula = gad7_anxiety_up01 ~ acha_depression_01 + sex +
race + year_1 + acha_12months_any_anorexia + acha_12months_any_anxiety +
acha_12months_any_bulimia + acha_12months_any_blood + acha_12months_any_bronchitis +
acha_12months_any_cholesterol + acha_12months_any_depression +
acha_12months_any_herpes + acha_12months_any_hpv + acha_12months_any_HIV +
acha_12months_any_seasonal + acha_12months_any_substance +
acha_12months_any_chlamydia + acha_12months_any_gonorrhea +
acha_12months_any_mononucleosis + acha_12months_any_allergy +
acha_12months_any_asthma + acha_12months_any_back + acha_12months_any_blood +
acha_12months_any_bronchitis + acha_12months_any_cholesterol +
acha_12months_any_diabetes + acha_12months_any_ear + acha_12months_any_endometriosi +
acha_12months_any_fatigure + acha_12months_any_hepatitis +
acha_12months_any_pelvic + acha_12months_any_sinus + acha_12months_any_strep +
acha_12months_any_stressInjury + acha_12months_any_tuberculosis +
general_health, family = binomial, data = anxietytrain_up)
Coefficients: (1 not defined because of singularities)
Estimate Std. Error z value Pr(>|z|)
(Intercept) -6.083e+01 5.484e+01 -1.109 0.267325
acha_depression_01 -8.527e-01 3.699e-01 -2.305 0.021146 *
sexMale -8.589e-02 2.751e-01 -0.312 0.754908
raceblack -1.191e+00 6.441e-01 -1.849 0.064514 .
racehispanic 3.091e-01 4.658e-01 0.664 0.506917
raceother 1.377e-01 5.502e-01 0.250 0.802351
racewhite 6.793e-01 3.454e-01 1.967 0.049204 *
year_1 2.903e-02 2.740e-02 1.060 0.289318
acha_12months_any_anorexiaYes 5.612e-01 4.326e-01 1.297 0.194569
acha_12months_any_anxietyYes 1.969e+00 2.894e-01 6.804 1.02e-11 ***
acha_12months_any_bulimiaYes -9.154e-02 6.633e-01 -0.138 0.890240
acha_12months_any_bloodYes 2.798e-01 6.407e-01 0.437 0.662346
acha_12months_any_bronchitisYes 6.547e-01 7.695e-01 0.851 0.394927
acha_12months_any_cholesterolYes 7.863e-01 5.834e-01 1.348 0.177729
acha_12months_any_depressionYes 5.103e-01 3.555e-01 1.435 0.151148
acha_12months_any_herpesYes -1.586e+01 9.149e+02 -0.017 0.986169
acha_12months_any_hpvYes -7.457e-01 1.661e+00 -0.449 0.653536
acha_12months_any_HIVYes 2.396e+00 3.184e+03 0.001 0.999400
acha_12months_any_seasonalYes -6.127e-03 3.260e-01 -0.019 0.985005
acha_12months_any_substanceYes -4.379e-01 4.642e-01 -0.943 0.345486
acha_12months_any_chlamydiaYes -4.745e-01 1.085e+00 -0.437 0.661917
acha_12months_any_gonorrheaYes -1.248e+01 1.524e+03 -0.008 0.993467
acha_12months_any_mononucleosisYes -1.852e+00 1.442e+00 -1.284 0.199069
acha_12months_any_allergyYes -1.546e-02 2.440e-01 -0.063 0.949483
acha_12months_any_asthmaYes 1.891e-01 3.595e-01 0.526 0.598899
acha_12months_any_backYes 2.279e-01 2.493e-01 0.914 0.360591
acha_12months_any_diabetesYes -2.035e+00 9.908e-01 -2.054 0.039988 *
acha_12months_any_earYes 1.595e-01 5.615e-01 0.284 0.776395
acha_12months_any_endometriosiYes -1.037e+00 7.446e-01 -1.393 0.163743
acha_12months_any_fatigureYes 1.486e+00 5.836e-01 2.547 0.010863 *
acha_12months_any_hepatitisYes -1.322e+01 1.105e+03 -0.012 0.990459
acha_12months_any_pelvicYes 2.591e+01 1.563e+03 0.017 0.986772
acha_12months_any_sinusYes 2.697e-01 3.118e-01 0.865 0.386968
acha_12months_any_strepYes 7.625e-02 4.618e-01 0.165 0.868842
acha_12months_any_stressInjuryYes -1.201e+00 7.243e-01 -1.659 0.097193 .
acha_12months_any_tuberculosisYes NA NA NA NA
general_healthFair 1.981e+00 6.005e-01 3.299 0.000969 ***
general_healthGood 1.076e+00 5.439e-01 1.979 0.047819 *
general_healthPoor 5.084e+00 1.143e+00 4.450 8.60e-06 ***
general_healthVery Good 7.039e-01 5.474e-01 1.286 0.198474
---
Signif. codes: 0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
(Dispersion parameter for binomial family taken to be 1)
Null deviance: 707.01 on 509 degrees of freedom
Residual deviance: 498.49 on 471 degrees of freedom
AIC: 576.49
Number of Fisher Scoring iterations: 15
Call:
glm(formula = gad7_anxiety_up01 ~ acha_services_diagnosed1 +
acha_services_medication1 + acha_services_therapy1, family = binomial,
data = anxietytrain_up)
Coefficients:
Estimate Std. Error z value Pr(>|z|)
(Intercept) 0.65072 0.26565 2.450 0.0143 *
acha_services_diagnosed1Yes 0.28035 0.35604 0.787 0.4310
acha_services_medication1Yes -0.28928 0.33247 -0.870 0.3843
acha_services_therapy1Yes -0.06037 0.34255 -0.176 0.8601
---
Signif. codes: 0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
(Dispersion parameter for binomial family taken to be 1)
Null deviance: 235.66 on 178 degrees of freedom
Residual deviance: 234.13 on 175 degrees of freedom
(331 observations deleted due to missingness)
AIC: 242.13
Number of Fisher Scoring iterations: 4
Braghieri, L., Levy, R., & Makarin, A. (2021). Social media and mental health. SSRN Electronic Journal, 112(11). https://doi.org/10.2139/ssrn.3919760
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092
Spring 2008 reference group executive summary. (n.d.). Retrieved September 20, 2025, from https://www.acha.org/wp-content/uploads/2024/07/ACHA-NCHA_Reference_Group_ExecutiveSummary_Spring2008.pdf
---
title: "Collegiate Mental Health "
author: "Audrey DeGregorio"
output:
flexdashboard::flex_dashboard:
theme:
version: 4
bootswatch: bootstrap
navbar-bg: "#B3CAD8"
orientation: columns
source_code: embed
---
```{r setup, include=FALSE}
pacman::p_load(flexdashboard, car, caret, Benchmarking, tidyverse, ggplot2)
library(tibble)
data <- read_csv("G:/My Drive/Fall 2025/MTH 369/Regression RStudio/Final Project/MentalHealthSurvey.csv")
data <- data |>
dplyr::select(c(RecordedDate, year_1, state_1, surveys, general_health, starts_with("phq9"), starts_with("gad7"), starts_with("acha_12months"), starts_with("acha_services"), acha_depression, sex, fulltime, international, starts_with("race")))
attach(data)
#creating race variable
data$race_white1 <- ifelse(data$race_white == "White - not Hispanic (includes Middle Eastern)", 1, 0)
data$race_asian1 <- ifelse(data$race_asian == "Asian or Pacific Islander", 1, 0)
data$race_black1 <- ifelse(data$race_black == "Black - not Hispanic", 1, 0)
data$race_hispanic1 <- ifelse(data$race_hispanic == "Hispanic or Latino", 1, 0)
data$race_native1 <- ifelse(data$race_native == "American Indian or Alaskan Native", 1, 0)
data$race_other1 <- ifelse(data$race_other == "Other", 1, 0)
race_count <- apply(data[,71:76], 1, function(x) sum(x, na.rm=T))
data <- data %>%
mutate(race_count_other = case_when(race_count > 1 ~ TRUE))
data <- data %>%
mutate(race = case_when(race_count > 1 ~ "other",
race_white1 == "1" ~ "white",
race_black1 == "1" ~ "black",
race_hispanic1 == "1" ~ "hispanic",
race_native1 == "1" ~ "native",
race_asian1 == "1" ~ "asian",
race_other1 == "1" ~ "other"))
glimpse(data)
data <- data |>
dplyr::select(c(RecordedDate, year_1, state_1, surveys, general_health, starts_with("phq9"), starts_with("gad7"), starts_with("acha_12months"), starts_with("acha_services"), acha_depression, sex, fulltime, international, race))
# phq9
data <- data %>%
mutate(phq9_interest1 = case_when(
phq9_interest == "Not at all" ~ 0,
phq9_interest == "Several days" ~ 1,
phq9_interest == "More than half of the days" ~ 2,
phq9_interest == "Nearly every day" ~ 3),
phq9_depressed1 = case_when(
phq9_depressed == "Not at all" ~ 0,
phq9_depressed == "Several days" ~ 1,
phq9_depressed == "More than half of the days" ~ 2,
phq9_depressed == "Nearly every day" ~ 3),
phq9_sleep1 = case_when(
phq9_sleep == "Not at all" ~ 0,
phq9_sleep == "Several days" ~ 1,
phq9_sleep == "More than half of the days" ~ 2,
phq9_sleep == "Nearly every day" ~ 3),
phq9_tired1 = case_when(
phq9_tired == "Not at all" ~ 0,
phq9_tired == "Several days" ~ 1,
phq9_tired == "More than half of the days" ~ 2,
phq9_tired == "Nearly every day" ~ 3),
phq9_appetite1 = case_when(
phq9_appetite == "Not at all" ~ 0,
phq9_appetite == "Several days" ~ 1,
phq9_appetite == "More than half of the days" ~ 2,
phq9_appetite == "Nearly every day" ~ 3),
phq9_failure1 = case_when(
phq9_failure == "Not at all" ~ 0,
phq9_failure == "Several days" ~ 1,
phq9_failure == "More than half of the days" ~ 2,
phq9_failure == "Nearly every day" ~ 3),
phq9_concentrating1 = case_when(
phq9_concentrating == "Not at all" ~ 0,
phq9_concentrating == "Several days" ~ 1,
phq9_concentrating == "More than half of the days" ~ 2,
phq9_concentrating == "Nearly every day" ~ 3),
phq9_speed1 = case_when(
phq9_speed == "Not at all" ~ 0,
phq9_speed == "Several days" ~ 1,
phq9_speed == "More than half of the days" ~ 2,
phq9_speed == "Nearly every day" ~ 3),
phq9_selfharm1 = case_when(
phq9_selfharm == "Not at all" ~ 0,
phq9_selfharm == "Several days" ~ 1,
phq9_selfharm == "More than half of the days" ~ 2,
phq9_selfharm == "Nearly every day" ~ 3),
phq9_score = (phq9_interest1 + phq9_depressed1 + phq9_sleep1 +
phq9_tired1 + phq9_appetite1 + phq9_failure1 +
phq9_concentrating1 + phq9_speed1 + phq9_selfharm1),
phq9_severity = case_when(
phq9_score <= 4 ~ "None-minimal",
phq9_score > 4 & phq9_score <= 9 ~ "Mild",
phq9_score >= 10 & phq9_score <= 14 ~ "Moderate",
phq9_score >= 15 & phq9_score <= 19 ~ "Moderately Severe",
phq9_score >= 20 ~ "Severe")
)
# gad7
data <- data %>%
mutate(gad7_anxious1 = case_when(
gad7_anxious == "Not at all" ~ 0,
gad7_anxious == "Several days" ~ 1,
gad7_anxious == "More than half of the days" ~ 2,
gad7_anxious == "Nearly every day" ~ 3),
gad7_control1 = case_when(
gad7_control == "Not at all" ~ 0,
gad7_control == "Several days" ~ 1,
gad7_control == "More than half of the days" ~ 2,
gad7_control == "Nearly every day" ~ 3),
gad7_worrying1 = case_when(
gad7_worrying == "Not at all" ~ 0,
gad7_worrying == "Several days" ~ 1,
gad7_worrying == "More than half of the days" ~ 2,
gad7_worrying == "Nearly every day" ~ 3),
gad7_relaxing1 = case_when(
gad7_relaxing == "Not at all" ~ 0,
gad7_relaxing == "Several days" ~ 1,
gad7_relaxing == "More than half of the days" ~ 2,
gad7_relaxing == "Nearly every day" ~ 3),
gad7_restless1 = case_when(
gad7_restless == "Not at all" ~ 0,
gad7_restless == "Several days" ~ 1,
gad7_restless == "More than half of the days" ~ 2,
gad7_restless == "Nearly every day" ~ 3),
gad7_annoyed1 = case_when(
gad7_annoyed == "Not at all" ~ 0,
gad7_annoyed == "Several days" ~ 1,
gad7_annoyed == "More than half of the days" ~ 2,
gad7_annoyed == "Nearly every day" ~ 3),
gad7_afraid1 = case_when(
gad7_afraid == "Not at all" ~ 0,
gad7_afraid == "Several days" ~ 1,
gad7_afraid == "More than half of the days" ~ 2,
gad7_afraid == "Nearly every day" ~ 3),
gad7_score = (gad7_anxious1 + gad7_control1 + gad7_worrying1 +
gad7_relaxing1 + gad7_restless1 + gad7_annoyed1 +
gad7_afraid1),
gad7_severity = case_when(
gad7_score <= 4 ~ "Minimal Anxiety",
gad7_score > 4 & gad7_score <= 9 ~ "Mild Anxiety",
gad7_score >= 10 & gad7_score <= 14 ~ "Moderate Anxiety",
gad7_score >= 15 ~ "Severe Anxiety"))
# ACHA depression diagnosis cleaning
data <- data %>%
mutate(acha_services_diagnosed1 = case_when(
acha_depression == "No" ~ NA,
TRUE ~ acha_services_dianosed),
acha_services_therapy1 = case_when(
acha_depression == "No" ~ NA,
TRUE ~ acha_services_therapy),
acha_services_medication1 = case_when(
acha_depression == "No" ~ NA,
TRUE ~ acha_services_medication))
attach(data)
```
Introduction
===
Column { data-width=500}
-----------------------------------------------------------------------
### <font size=4><span Style = "color:#2C7BB6"> Background</span></font>
The purpose of this project is to explore relationships among mental and physical health issues, and predictors of anxiety and depression among college students. While mental health is sometimes hard to measure, there are standardized methods developed to help psychologists evaluate the presence and severity of certain mental health indicators. In this project, we will focus mainly on depression and anxiety disorders in relation to overall mental health.
Our physical and mental health are not distinct from each other. It is important to view health from an overall perspective, because all areas of our lives cross over into each other.
### <font size=4><span Style = "color:#2C7BB6"> Research Questions</span></font>
- What physical health issues are related to mental health outcomes?
- How does the physical health and mental health (depression/anxiety scores) of students who receive mental health treatment (therapy, medication) compare to students that do not?
- Are mental and physical health problems consistent across sex, race, and age?
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<font size=4><span Style = "color:#2C7BB6"> Data Description</span></font>
### Source
The data set comes from a study based on social media's affects on college students' mental health (Braghieri, et. al 2021). The data includes variables with information from PHQ-9 Depression Screening Surveys and GAD-7 Anxiety Screening Surveys. Both are highly reliable and valid in medical diagnoses. Additionally, there are survey questions derived from the American College Health Association (ACHA)'s National College Health Assessment (NCHA). This data set was originally used to evaluate the validity of the NCHA by comparing the outcomes to the PHQ-9 and the GAD-7, both of which were highly correlated to the poor mental health predictors of the NCHA. There are 509 observations.
```{r}
glimpse(data)
```
### PHQ-9
The [PHQ-9](https://doi.org/10.1046/j.1525-1497.2001.016009606.x) is a standardized survey used to screen and diagnose depression. Participants are asked how often they have been bothered by nine specific problems over the past two weeks and respond with one of the four answers:
1. Not at all (+0)
2. Several days(+1)
3. More than half the days (+2)
4. Nearly everyday (+3)
The nine prompts consist of the following:
1. Little interest or pleasure in doing things
2. Feeling down, depressed or hopeless
3. Trouble falling asleep, staying asleep, or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself - or that you’re a failure or have let yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper or watching television
8. Moving or speaking so slowly that other people could have noticed. Or, the opposite - being so fidgety or restless that you have been moving around a lot more than usual
9. Thoughts that you would be better off dead or of hurting yourself in some way
Surveys are then scored and indicate levels of depression based on this scale:
- **0-4** None-minimal
- **5-9** Mild
- **10-14** Moderate
- **15-19** Moderately Severe
- **20-27** Severe
### GAD-7
Similar to the PHQ-9, the [GAD-7](https://doi.org/10.1001/archinte.166.10.1092) another is standardized survey, but it is used to screen generalized anxiety disorder. Participants are asked how often they have been bothered by seven specific problems over the past two weeks and respond with one of the four answers:
1. Not at all (+0)
2. Several days(+1)
3. More than half the days (+2)
4. Nearly everyday (+3+)
The nine prompts consist of the following:
1. Feeling nervous, anxious or on edge
2. Not being able to stop or control worrying
3. Worrying too much about different things
4. Trouble relaxing
5. Being so restless that it is hard to sit still
6. Becoming easily annoyed or irritable
7. Feeling afraid as if something awful might happen
Surveys are then scored and indicate levels of anxiety based on this scale:
- **0-4** Minimal anxiety
- **5-9** Mild anxiety
- **10-14** Moderate anxiety
- **15+** Severe anxiety
### NCHA
The [National College Health Assessment](https://www.acha.org/wp-content/uploads/2024/07/ACHA-NCHA_Reference_Group_ExecutiveSummary_Spring2008.pdf) is a semi-annual survey administered to college students by the ACHA. The current data utilizes the survey questions, but not the data collected from the ACHA.
The data includes the following prompts from the survey:
**Depression Symptoms:**
- Feeling things were hopeless
- Feeling overwhelmed by all they had to do
- Feeling very sad
- Feeling so depressed it was difficult to
function
- Seriously considering attempting suicide
- Attempting suicide
*Possible Responses:*
- Never
- 1-2 times
- 3-4 times
- 5-6 times
- 7-8 times
- 9-10 times
- 11 or more times
**General Health Indicators:**
Reported any of the following in the past 12 months:
- Allergy problems
- Anorexia
- Anxiety disorder
- Asthma
- Bulimia
- Chronic fatigue syndrome
- Depression
- Diabetes
- Endometriosis
- Genital herpes
- Genital warts/HPV
- Hepatitis B or C
- High blood pressure
- High cholesterol
- HIV infection
- Repetitive stress injury
- Seasonal affective disorder
- Substance abuse problem
- Back pain
- Broken bone/fracture
- Bronchitis
- Chlamydia
- Ear infection
- Gonorrhea
- Mononucleosis
- Pelvic inflammatory disease
- Sinus infection
- Strep throat
- Tuberculosis
*Possible Responses:*
- Yes/No
- NA
If diagnosed with depression:
- Diagnosed with depression in the last school year
- Currently in therapy for depression
- Currently taking medication for depression
*Possible Responses:*
- Yes/No
- NA
### Data Cleaning
Many variables that were not useful for the research questions and were removed from the data set. Most of these include timestamps from clicks in the survey and other online browser information.
Other variables were created and transformed for ease of use. For example, race was condensed into one category with information for all races as opposed to 6 different variables with two levels.
Additionally, variables were created to represent the overall depression and anxiety scores from the PHQ-9 and GAD-7 screening results.
EDA
=================
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<font size=4><span Style = "color:#2C7BB6">Discussion</span></font>
### PHQ-9:GAD-7
**Figure 1**
This graph provides some insight into the relationship between overall PHQ-9 and GAD-7 scores. The R-Squared = 0.605 and the regression line is fitted by a linear regression between the variables. There is a moderate, positive relationship between the depression and anxiety scores based on these survey questions.
### PHQ-9 Results
**Figure 2**
Figure 2 shows the distribution of depression severity based on the PHQ-9. Most students fall under the Mild category, with less having more severe scores.
### GAD-7 Results
**Figure 3**
Figure 3 shows the distribution of anxiety severity based on the GAD-7. The results are similar to the distribution of depression, with most students exhibiting symptoms equivalent to mild anxiety and less facing severe symptoms.
### Sex
**Figure 4**
Figure 4 shows how many male and female students are included in the dataset. There are approximately 350 females and 150 males.
### Race
**Figure 5**
Most students identify as white, with almost 300 students reporting so. All students who idenfied as more than one race are classified as "other".
### Age
**Figure 6**
Most students were born in the year 2000, with a long tail representing multiple older students also represented in the sample. **Note:** This data was collected in January 2022, so most students born in 2000 are around 21 years old.
### Physical Health
**Figure 7**
This graph shows the amount of people who responded "yes" to experiencing each of the symptoms/disorders listed in the past 12 months. Anxiety, depression, allergies, and back pain are among the most common.
It is worth noting these measures of depression and anxiety are different from the PHQ-9 and GAD-7 scales, and were an independent, self-reported question in the NCHA questionnaire.
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<font size=4><span Style = "color:#2C7BB6">Corresponding Graphs</span></font>
### Fig. 1
```{r fig. 1 phq9 gad7 cor}
ggplot(data, aes(phq9_score, gad7_score)) +
geom_point() +
labs(title = "PHQ-9 and GAD-7 Correlation", x = "PHQ-9 Score", y = "GAD-7 Score") +
geom_smooth(method = "lm", se = FALSE, col = "#C7A9A1")
```
### Fig. 2
```{r fig.2 phq9 bar}
data$phq9_severity <- factor(data$phq9_severity,
levels = c("None-minimal", "Mild", "Moderate", "Moderately Severe", "Severe"))
ggplot(data,aes(phq9_severity)) +
geom_bar(fill = "#C7A9A1") +
labs(title = "PHQ-9 Results", x = "Severity")
```
### Fig. 3
```{r fig.3 gad7 bar}
data$gad7_severity <- factor(data$gad7_severity,
levels = c("Minimal Anxiety", "Mild Anxiety", "Moderate Anxiety", "Severe Anxiety"))
ggplot(data,aes(gad7_severity)) +
geom_bar(fill = "#C7A9A1") +
labs(title = "GAD-7 Results", x = "Severity")
```
### Fig. 4
```{r sex}
ggplot(data, aes(sex)) +
geom_bar(fill="#C7A9A1") +
labs(title = "Sex Distribution", x = "Sex")
```
### Fig. 5
```{r race}
ggplot(data, aes(race)) +
geom_bar(fill="#C7A9A1") +
labs(title = "Race Distribution", x = "Race")
```
### Fig. 6
```{r age}
ggplot(data, aes(year_1)) +
geom_bar(fill="#C7A9A1") +
labs(title = "Age Distribution", x = "Birth Year")
```
### Fig. 7
```{r}
acha <- data %>%
pivot_longer(
cols = c(acha_12months_any_allergy:acha_12months_any_tuberculosis), #
names_to = "variable",
values_to = "response") %>%
filter(response == "Yes")
ggplot(acha, aes(x = variable, fill = response)) +
geom_bar(position = "dodge") +
scale_fill_manual(values = c("Yes" = "#C7A9A1")) +
scale_x_discrete(labels = c(
acha_12months_any_allergy = "Allergy",
acha_12months_any_anorexia = "Anorexia",
acha_12months_any_anxiety = "Anxiety",
acha_12months_any_asthma = "Asthma",
acha_12months_any_back = "Back Pain",
acha_12months_any_blood = "High BP",
acha_12months_any_bronchitis = "Bronchitis",
acha_12months_any_bulimia = "Bulimia",
acha_12months_any_cholesterol = "High Cholesterol",
acha_12months_any_depression = "Depression",
acha_12months_any_diabetes = "Diabetes",
acha_12months_any_ear = "Ear Infection",
acha_12months_any_endometriosi = "Endometriosis",
acha_12months_any_fatigure = "Chronic Fatigue",
acha_12months_any_fracture = "Broken Bone",
acha_12months_any_gonorrhea = "Gonorrhea",
acha_12months_any_hepatitis = "Hepatitis",
acha_12months_any_herpes = "Genital Herpes",
acha_12months_any_HIV = "HIV",
acha_12months_any_hpv = "HPV",
acha_12months_any_mononucleosis = "Mononucleosis",
acha_12months_any_pelvic = "Pelvic Inflammatory Disease",
acha_12months_any_seasonal = "Seasonal Affective Disorder",
acha_12months_any_sinus = "Sinus Infection",
acha_12months_any_strep = "Strep Throat",
acha_12months_any_substance = "Substance Abuse Disorder",
acha_12months_any_tuberculosis = "Tuberculosis",
acha_12months_any_chlamydia = "Chlamydia",
acha_12months_any_stressInjury = "Repetitive Stress Injury")) +
labs(title = "NCHA Questionnaire Results",x = "Report Experiencing in the Past 12 Months", y = "Count") +
theme_minimal() +
theme(axis.text.x = element_text(angle = 45, hjust = 1), legend.position = "none")
```
Methods
===
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---
### 1
### 2
gekk
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---
### Model
```{r depression}
data <- data %>%
mutate(acha_depression_01 =
case_when(acha_depression == "Yes" ~ 1,
acha_depression == "No" ~ 0)
)
set.seed(2626)
train_index <- createDataPartition(data$acha_depression_01, p = 0.8, list = FALSE)
train <- data[train_index,]
test <- data[-train_index,]
table(train$acha_depression)
table(test$acha_depression)
logit_model <- glm(acha_depression_01 ~ sex + race + year_1 + phq9_score + gad7_score + general_health, data = train, family = binomial)
summary(logit_model)
logit_model2 <- glm(acha_depression_01 ~ sex + race + year_1 + acha_12months_any_allergy + acha_12months_any_asthma + acha_12months_any_back + acha_12months_any_blood +acha_12months_any_bronchitis + acha_12months_any_cholesterol +acha_12months_any_diabetes + acha_12months_any_ear +acha_12months_any_endometriosi +acha_12months_any_fatigure +acha_12months_any_hepatitis +acha_12months_any_pelvic +acha_12months_any_sinus+ acha_12months_any_strep +acha_12months_any_stressInjury+ acha_12months_any_tuberculosis + general_health, data = train, family = binomial)
summary(logit_model2)
model_train3 <- glm(acha_depression_01 ~ sex + race + year_1 + acha_12months_any_anorexia + acha_12months_any_anxiety + acha_12months_any_bulimia + acha_12months_any_blood +acha_12months_any_bronchitis + acha_12months_any_cholesterol +acha_12months_any_depression + acha_12months_any_herpes +acha_12months_any_hpv +acha_12months_any_HIV +acha_12months_any_seasonal +acha_12months_any_substance +acha_12months_any_chlamydia+ acha_12months_any_gonorrhea +acha_12months_any_mononucleosis + general_health, data = train, family = binomial)
summary(model_train3)
table(acha_12months_any_gonorrhea)
table(train$acha_12months_any_gonorrhea)
model_train4 <- glm(acha_depression_01 ~ sex + race + year_1 + acha_12months_any_anorexia + acha_12months_any_anxiety + acha_12months_any_bulimia + acha_12months_any_blood +acha_12months_any_bronchitis + acha_12months_any_cholesterol +acha_12months_any_depression + acha_12months_any_herpes +acha_12months_any_hpv +acha_12months_any_HIV +acha_12months_any_seasonal +acha_12months_any_substance +acha_12months_any_chlamydia +acha_12months_any_mononucleosis+ acha_12months_any_allergy + acha_12months_any_asthma + acha_12months_any_back + acha_12months_any_blood +acha_12months_any_bronchitis + acha_12months_any_cholesterol +acha_12months_any_diabetes + acha_12months_any_ear +acha_12months_any_endometriosi +acha_12months_any_fatigure +acha_12months_any_hepatitis +acha_12months_any_pelvic +acha_12months_any_sinus+ acha_12months_any_strep +acha_12months_any_stressInjury+ general_health, data = train, family = binomial)
summary(model_train4)
table(acha_12months_any_tuberculosis)
vif(model_train4)
```
```{r anxiety}
## 10 is the general cut off for clinical intervention
table(gad7_severity)
data <- data %>%
mutate(gad7_anxiety =
case_when(gad7_severity == "Mild Anxiety" |gad7_severity == "Minimal Anxiety" ~ "No",
gad7_severity == "Moderate Anxiety" | gad7_severity =="Severe Anxiety" ~ "Yes"))
data$gad7_anxiety <- as.factor(data$gad7_anxiety)
set.seed(2626)
train_index <- createDataPartition(data$gad7_anxiety, p = 0.8, list = FALSE)
train <- data[train_index,]
test <- data[-train_index,]
table(train$gad7_anxiety)
anxietytrain_up <- upSample(x = train[, -which(names(train) == "gad7_anxiety")],
y = train$gad7_anxiety)
table(anxietytrain_up$Class)
names(anxietytrain_up)[ncol(anxietytrain_up)] <- "gad7_anxiety_up"
table(anxietytrain_up$gad7_anxiety_up)
anxietytrain_up <- anxietytrain_up %>%
mutate(gad7_anxiety_up01 =
case_when(gad7_anxiety_up == "Yes" ~ 1,
gad7_anxiety_up == "No" ~ 0)
)
table(anxietytrain_up$gad7_anxiety_up01)
anx_model <- glm(gad7_anxiety_up01 ~ sex + race + year_1 + phq9_score + general_health, data = anxietytrain_up, family = binomial)
summary(anx_model)
anx_model2 <- glm(gad7_anxiety_up01 ~ sex + race + year_1 + acha_12months_any_allergy + acha_12months_any_asthma + acha_12months_any_back + acha_12months_any_blood +acha_12months_any_bronchitis + acha_12months_any_cholesterol +acha_12months_any_diabetes + acha_12months_any_ear +acha_12months_any_endometriosi +acha_12months_any_fatigure +acha_12months_any_hepatitis +acha_12months_any_pelvic +acha_12months_any_sinus+ acha_12months_any_strep +acha_12months_any_stressInjury+ acha_12months_any_tuberculosis + general_health, data = anxietytrain_up, family = binomial)
summary(anx_model2)
anx_model3 <- glm(gad7_anxiety_up01 ~ acha_depression_01 + sex + race + year_1 + acha_12months_any_anorexia + acha_12months_any_anxiety + acha_12months_any_bulimia + acha_12months_any_blood +acha_12months_any_bronchitis + acha_12months_any_cholesterol +acha_12months_any_depression + acha_12months_any_herpes +acha_12months_any_hpv +acha_12months_any_HIV +acha_12months_any_seasonal +acha_12months_any_substance +acha_12months_any_chlamydia+ acha_12months_any_gonorrhea +acha_12months_any_mononucleosis + general_health, data = anxietytrain_up, family = binomial)
summary(anx_model3)
anx_model4 <- glm(gad7_anxiety_up01 ~ acha_depression_01 + sex + race + year_1 + acha_12months_any_anorexia + acha_12months_any_anxiety + acha_12months_any_bulimia + acha_12months_any_blood +acha_12months_any_bronchitis + acha_12months_any_cholesterol +acha_12months_any_depression + acha_12months_any_herpes +acha_12months_any_hpv +acha_12months_any_HIV +acha_12months_any_seasonal +acha_12months_any_substance +acha_12months_any_chlamydia+ acha_12months_any_gonorrhea +acha_12months_any_mononucleosis+ acha_12months_any_allergy + acha_12months_any_asthma + acha_12months_any_back + acha_12months_any_blood +acha_12months_any_bronchitis + acha_12months_any_cholesterol +acha_12months_any_diabetes + acha_12months_any_ear +acha_12months_any_endometriosi +acha_12months_any_fatigure +acha_12months_any_hepatitis +acha_12months_any_pelvic +acha_12months_any_sinus+ acha_12months_any_strep +acha_12months_any_stressInjury+ acha_12months_any_tuberculosis + general_health, data = anxietytrain_up, family = binomial)
summary(anx_model4)
```
```{r treatment}
atreatment_model <- glm(gad7_anxiety_up01 ~ acha_services_diagnosed1 + acha_services_medication1 + acha_services_therapy1, data=anxietytrain_up, family = binomial)
summary(atreatment_model)
```
### Diagnostics
Discussion
===
### Results
### References
Braghieri, L., Levy, R., & Makarin, A. (2021). Social media and mental health. *SSRN Electronic Journal, 112*(11). https://doi.org/10.2139/ssrn.3919760
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. *Journal of General Internal Medicine, 16*(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. *Archives of Internal Medicine, 166*(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092
*Spring 2008 reference group executive summary.* (n.d.). Retrieved September 20, 2025, from https://www.acha.org/wp-content/uploads/2024/07/ACHA-NCHA_Reference_Group_ExecutiveSummary_Spring2008.pdf